Support Tests.

Sherri Loeb sherriloeb at GMAIL.COM
Mon Jan 25 20:57:26 UTC 2016


Thanks so all. I am not sure what your mean rob about my American
Urological Association comment on my form?

Anyway, keep up the good work.

On Mon, Jan 25, 2016 at 2:53 PM, robert bell <rmsbell200 at yahoo.com> wrote:

> Thanks Sherri and Lucy.
>
> It would seem good to work towards greater standardization nation wide.
>
> Sherri your American Urological Association comment on your forms may have
> prevented the problem that I heard about. I wonder how many lab forms have
> and do not have that statement?
>
> Also, I notice that different labs use different kinds of forms to report
> their results. Different font sizes, different additional information, etc.
> Do these in any way lead to error or prevent error? Standardization here
> would also be good. But if that does not happen should all forms first
> tested with say 500 HCPs to see that there are no common
> errors/misunderstandings that can be easily corrected. Perhaps they are?
>
> Is the laboratory world represented on the Post IOM diagnostic consortium
> group? If not that would be valuable.
>
> Simple things first!
>
> Rob Bell MD.
>
> On Jan 25, 2016, at 12:41 PM, Sherri Loeb <sherriloeb at GMAIL.COM> wrote:
>
> I find this comment particularly interesting considering my husband passed
> away from metastatic prostate cancer. One he was diagnosed. We noticed that
> occasionally his psa was ordered as psa screening to check response to
> chemo and hormone therapy and other times as psa diagnostic. We were told
> it is exactly the same. From reading this email, it is obviously not the
> same.
>
> Thanks for the clear explanation.
>
> Sherri Loeb RN, BSN
>
> On Mon, Jan 25, 2016 at 1:01 PM, Knapp, Lucy <LKnapp at peacehealthlabs.org>
> wrote:
>
>> In a word – speaking for the laboratory world – Communicate those needs
>> to your laboratories. As an example, here we have two tests, “PSA,
>> Screening” which has a reference range up to 4 and “PSA, Diagnostic” which
>> also has a reference range of up to 4 but also includes an interpretative
>> comment: “According to the American Urological Association (AUA), serum
>> PSA should decrease and remain at undetectable levels after radical
>> prostatectomy. The AUA defines biochemical recurrence as an initial PSA
>> value of greater than or equal to 0.20 ng/mL followed by a subsequent
>> confirmatory PSA value of greater than or equal to 0.20 ng/mL.”
>>
>>
>>
>> In a prior life – we had 2 tests with different reference ranges, plus a
>> comment on the PSA, Diagnostic. Both options are easily done in an LIS (lab
>> information system).
>>
>>
>>
>> We in the laboratory would love to have better communication from
>> physicians – we want to make your lives easier. So my advice to all the
>> physicians out there is to build relationships with the pathologists and
>> laboratory personnel where you practice. Let us know where improvement is
>> needed to the LIS, you need a new test, you need better sensitivity on a
>> current test – whatever.
>>
>>
>>
>> I’m copying the to our medical director, we are trying to establish
>> better communication with our physicians throughout our system.
>>
>>
>>
>> Lucy
>>
>>
>>
>> *Lucy Knapp, MT(ASCP) *  |  Technical Specialist, Chemistry  |
>> Laboratory
>>
>> *PeaceHealth* <http://www.peacehealth.org/>  |  400 NE Mother Joseph
>> Place  |  Vancouver, WA 98664
>>
>> *office* 360-514-2732  |  *fax* 360-514-1646
>>
>>
>>
>> *From:* robert bell [mailto:
>> 0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG]
>> *Sent:* Sunday, January 24, 2016 1:56 PM
>> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> *Subject:* [IMPROVEDX] Support Tests.
>>
>>
>>
>> I have suggested that at the same time, or even before we tackle Errors
>> in Diagnosis, we see that all our support diagnostic tests (Lab, X-ray,
>> etc.) are in good order so as to help make the correct diagnoses more often.
>>
>>
>>
>> I have been made aware that it is easy to miss a low but rising PSA in
>> someone who has had a past radical prostatectomy.
>>
>>
>>
>> The Lab reports results as ng/mL with a reference range of (0.000 -
>> 4.000). The range for someone with a prostate present.
>>
>>
>>
>> I asked myself with all the technology is there anything that could be
>> done to prevent such happenings?
>>
>>
>>
>> And then I thought there must be 100s of similar situations when time,
>> disease, surgery, treatments, etc effect lab interpretations - the PSA lab
>> reports on the ones I have seen do not mention that the ranges are for
>> someone with a prostate. Should they?
>>
>>
>>
>> Yes, good clinical skills would help but could the lab with or without
>> technology do anything to help avoid such problems?  Could training or
>> anything else help prevent?
>>
>>
>>
>> I wondered how often this happens - and if you decided to do something
>> about it, could you triage it - presumably not without good error data!?
>>
>>
>>
>> Robert Bell
>>
>>
>>
>>
>>
>>
>>
>>
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>>
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>>
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>>
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>
>
>
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>
> To unsubscribe from IMPROVEDX: click the following link:
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>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
>
> Robert M. Bell, M.D., Ph.C.
> P.O. Box 3668
> West Sedona, AZ  86340-3668
> USA
> Tel: Fax: 928 203-4517
>
>
>
>






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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